Alcoholism and Alcohol Liver Disease from a Transplant Hepatology Perspective
|
|
- Debra Baldwin
- 6 years ago
- Views:
Transcription
1 Alcoholism and Alcohol Liver Disease from a Transplant Hepatology Perspective Clark Kulig, MD Director, Porter Center for Liver Care Denver, CO February 2015
2 Does quantity of alcohol correlate with liver disease? How can problematic drinking be detected? Moral Issue vs. Disease? Should alcoholics receive liver transplantation?
3 Objectives Outline the behavioral diagnoses associated with alcohol use Understand the types of alcohol liver disease Summarize therapeutic options for alcohol liver disease
4 Alcohol Hath Drowned More Men than the Sea Two-thirds of Americans drink alcohol 10% of Americans (10 million people) abuse alcohol 12-18% lifetime prevalence of alcohol abuse or dependence #2 (with HCV) and #3 indication for liver transplantation Vaillant G, Natural History of Alcoholism,
5 Behavioral Alcohol Diagnoses Alcohol Use Alcohol Abuse Alcohol Dependence
6 Alcohol Dependence = Alcoholism Behavioral Criteria Drinking despite negative consequences Health, Legal, Social Relationships, Occupation Loss of Control Physical Criteria Withdrawal Tolerance Alcohol Abuse 1-2 problematic issues from the criteria above Alcohol Use None of the issues noted above
7 Treatment of Alcoholism Readiness for Change? Pharmacologic Therapy Disulfiram (Antabuse) Acomprosate Naltrexone Provision of Structure Alcohol Monitoring, clinic visits Inpatient vs Outpatient Programs Psychological Therapy Cognitive Behavioral Therapy Alcoholics Anonymous Exercise Programs
8 Alcohol Liver Disease Steatosis Alcoholic Steatohepatitis Cirrhosis mild AST, ALT abdominal distention AST>ALT 2:1 jaundice platelets<12 ascites, LEE varices, HCC encephalopathy
9 Treatment of Alcohol Liver Disease Abstinence Nutrition Steroids Liver Transplantation
10 Treatment of Acute Alcohol Hepatitis Maddrey Discriminant Function (MDF) ( PT x 4.5) + bilirubin MDF Consider Prednisolone 40mg PO daily for 30 days Exclusions untreated infection renal failure GI bleeding
11 Should Alcoholics Receive Liver Transplantation? 1. High Demand for Liver Transplantation 2. Limited Supply of Organ Grafts 3. Who decides? (Society, UNOS, CMS/Insurance, Transplant Center, PCP, ER MD, ICU team) 4. Is Alcoholism Morally Blameworthy vs. Disease Process? (HCV Cirrhosis/IVDA) (Fatty Liver Disease/Bacon)
12 Alcohol Liver Disease and Liver Transplant Alcohol use common in US Only 10-15% of chronic heavy drinkers develop hepatic cirrhosis Cirrhosis often diagnosed at first hepatic decompensation Second most common indication for liver transplant, (20%) Vaillant G, Natural History of Alcoholism
13 Liver Transplant Successful in Alcohol Cirrhosis 41 patients with alcoholism transplanted , early cyclosporine era one-year survival was 73.2% three year survival was 68% 2/35 surviving >6 months returned to alcohol use Starzl T, JAMA 1988
14 Liver Transplant Successful in 99 alcoholic patients Alcohol Cirrhosis 45 received liver transplant 78 and 73% survival at 12 and 24 months survival not different from non-alcohol transplants better survival than HCV transplants 17 too well for transplant 19 medical exclusions, none survived one year 17 psych exclusions, 43% survived 18 months Lucey M and Beresford T, Gastro 1992
15 Liver Transplant Successful in Alcoholic Cirrhosis 84% one year survival 72% five year survival 23% five year survival without transplant alcoholic cirrhosis survival > HCV survival Bellamy C, Transplantation 2001
16 Alcoholics Do Well after Transplant Full integration into society is likely after liver transplant Cowling T, Ann Surg 2004
17 Six Month Rule Used by 85% of liver transplant centers, generally in setting of alcoholism UNOS/CMS minimal regulation Decision making at level of transplant center Medical literature: controversial interval Insurance companies: adopted dogma Lucey M, Liver Transplantation, July 2011
18 Six Month Rule Kumar: 73 individuals with alcoholism <6 months of abstinence 3/7 relapsed >6 months of abstience 3/45 relapsed Two smaller, retrospective, non-controlled studies (n=7, 24) Difficulty aquiring alcohol use data Kumar S, Hepatology 90 Osorio R Hepatology 94 Bird J, BMJ 90
19 Estimating Prognosis for Abstinence Favorable Factors insight into addiction social stability (job/housing/spouse) substitute activities level of self-esteem/hope rehabilitation relationship with nondrinker negative consequences (antabuse/pancreatic pain) Vaillant G, Natural History of Alcoholism
20 Estimating Prognosis for Abstinence Unfavorable Factors preexisting psychotic disorders/unstable character disorders multidrug abuse repeated and unsuccessful attempts at rehabilitation social isolation Vaillant G, Natural History of Alcoholism
21 Estimating the Prognosis for Abstinence after Liver Transplant 1. No single measure is a reliable prognosticator for future relapses into harmful drinking after transplantation. 2. With respect to admitting recent use, patients with alcoholism who are under consideration for LT have a conflict of interest. 3. Duration of abstinence is an imprecise prognostic tool. 4. Liver biopsy provides an unreliable estimate of recent alcohol use. 5. A careful evaluation by a trained addiction specialist with a special interest in transplant medicine is very helpful. Lucey M, Liver Transplantation, July 2011
22 Estimating the Prognosis for Abstinence after Liver Transplant 6. The psychosocial assessment determines lower and higher risks of relapsing into harmful drinking but does not determine the absolute risk. 7. The psychological assessment needs to be incorporated into a more comprehensive consideration of the appropriateness of liver transplant for a particular patient. 8. The severely ill patient who has been drinking recently but has other favorable prognostic indicators with respect to addiction poses a very difficult question for a transplant program. Lucey M, Liver Transplantation, July 2011
23 Porter Liver Transplant Alcohol Protocol 1. Six Month Sobriety rule used for mild/moderate chronic liver disease when alcohol dependence present 2. Alcohol Diagnosis/Prognosis Hepatology, Psychologist, Licensed Clinical Social Worker 3. Transplant Candidacy decisions via Selection Committee: Hepatology, Surgery, Psych, Social Work, Financial Coordinator, Nurse Coordinator, Dietician, Admin 4. Selection Committee makes decisions when there is severe disease with minimal abstinence
24 Objectives Outline the behavioral diagnoses associated with alcohol use Understand the types of alcohol liver disease Summarize therapeutic options for alcohol liver disease
CHAPTER 1. Alcoholic Liver Disease
CHAPTER 1 Alcoholic Liver Disease Major Lesions of Alcoholic Liver Disease Alcoholic fatty liver - >90% of binge and chronic drinkers Alcoholic hepatitis precursor of cirrhosis Alcoholic cirrhosis end
More informationACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries
ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries Ashwani K. Singal, MD, MS, FACG 1, Ramon Bataller, MD, PhD, FACG 2, Joseph Ahn, MD, MS, FACG (GRADE Methodologist) 3, Patrick S. Kamath,
More informationAlcoholic Hepatitis: Management Options
Alcoholic Hepatitis: Management Options Paul J. Thuluvath, MD. FRCP Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore Professor of Surgery & Medicine, Georgetown University,
More informationAlcoholic Hepatitis: Routine Screening for Early Recognition and Management. Juan Guerrero, MD
Alcoholic Hepatitis: Routine Screening for Early Recognition and Management Juan Guerrero, MD Global Problem 1% of GNP of medium/high income countries Additional societal costs Disproportionately affects
More informationOVERVIEW OF ALD ALCOHOLIC LIVER DISEASE DISCLOSURE
ALCOHOLIC LIVER DISEASE KEVIN D MULLEN MD West Virginia University Morgantown WV DISCLOSURE I have nothing to disclose. AMOUNT OF ALCOHOL PER STANDARD DRINK > (30 ) GRAM OF ALCOHOL PER DAY USA Canada UK
More informationPatterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function / liver function
More informationPatterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function tests / tests of
More informationHepatology for the Nonhepatologist
Hepatology for the Nonhepatologist Kenneth E. Sherman, MD, PhD Gould Professor of Medicine Director, Division of Digestive Diseases University of Cincinnati College of Medicine Cincinnati, Ohio Learning
More informationPaul Martin, MD, FACG. University of Miami. 30,000 deaths from cirrhosis per annum, alcohol implicated in 48%
Paul Martin, MD, FACG University of Miami 30,000 deaths from cirrhosis per annum, alcohol implicated in 48% Second commonest indication for liver transplant NIAA 2007 Page 1 of 26 Risk Factors Medical
More informationAmmonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis
Gastroenterology Report, 5(3), 2017, 232 236 doi: 10.1093/gastro/gow010 Advance Access Publication Date: 1 May 2016 Original article ORIGINAL ARTICLE Ammonia level at admission predicts in-hospital mortality
More informationAbhinandana Anantharaju, M.D., and David H. Van Thiel, M.D.
Liver Transplantation for Alcoholic Liver Disease Abhinandana Anantharaju, M.D., and David H. Van Thiel, M.D. In many patients, long-term heavy drinking leads to chronic liver disease, liver failure, and
More informationAlcohol-Related Liver Disease
Alcohol-Related Liver Disease Nonalcoholic Fatty Liver Disease (NAFLD) 1 Why is the liver important? Your liver is a vital organ that performs many essential functions. It filters out harmful substances
More informationManagement of Alcoholic Liver Disease. Hafez Fakheri Professor of medicine, Sari, Iran
Management of Alcoholic Liver Disease Hafez Fakheri Professor of medicine, Sari, Iran Alcoholic Hepatitis Scores DF = (4.6 x [ PT- control PT]) + (bili ) MELD = 10 * ((0.957 * ln(cr)) + (0.378 * ln(bil))
More informationLiver Transplant: Alcoholic liver disease as first indication
Monotematica AISF The future of liver disease: beyond HCV there is a role for hepatologist? Milano, 13-15 Ottobre 2016 Liver Transplant: Alcoholic liver disease as first indication Giacomo Germani Multivisceral
More informationHepatology For The Nonhepatologist
Hepatology For The Nonhepatologist Andrew Aronsohn, MD Associate Professor of Medicine University of Chicago Chicago, Illinois Learning Objectives After attending this presentation, learners will be able
More informationHCV care after cure. This program is supported by educational grants from
HCV care after cure This program is supported by educational grants from Raffaele Bruno,MD Department of Infectious Diseases, Hepatology Outpatients Unit University of Pavia Fondazione IRCCS Policlinico
More informationCauses of Liver Disease in US
Learning Objectives Updates in Outpatient Cirrhosis Management Jennifer Guy, MD MAS Director, Liver Cancer Program California Pacific Medical Center guyj@sutterhealth.org Review cirrhosis epidemiology,
More informationLiver Transplantation for the Primary Care Provider. Atif Zaman MD MPH Oregon Health & Sciences University
Liver Transplantation for the Primary Care Provider Atif Zaman MD MPH Oregon Health & Sciences University Disclosures 1. The speaker/planner Atif Zaman, MD MPH have no relevant financial relationships
More informationAbnormal LFTs in migrant populations. Dr Doug Macdonald Consultant Hepatologist Royal Free Hospital
Abnormal LFTs in migrant populations Dr Doug Macdonald Consultant Hepatologist Royal Free Hospital www.migrationobservatory.ox.ac.uk Migrants in London Migrants in London Migrants in London Common liver
More informationConflicts of Interest in the last 12 months
STEATOHEPATITIS Richard K. Sterling, MD, MSc, FACP, FACG VCU Hepatology Professor of Medicine Chief, Section of Hepatology Virginia Commonwealth University Richmond, VA Conflicts of Interest in the last
More informationACG Clinical Guideline: Alcoholic Liver Disease
CLINICAL GUIDELINES 1 ACG Clinical Guideline: Alcoholic Liver Disease Ashwani K. Singal, MD, MS, FACG 1, R amon B at a l l e r, M D, Ph D, FAC G 2, Joseph Ahn, MD, MS, FACG (GRADE Methodologist) 3, Patrick
More informationAcute Liver Failure. Neil Shah, MD UNC School of Medicine High-Impact Hepatology Saturday, Dec 8 th, 2018
Acute Liver Failure Neil Shah, MD UNC School of Medicine High-Impact Hepatology Saturday, Dec 8 th, 2018 Disclosures None Outline Overview of ALF Management of ALF Diagnosis of ALF Treatments and Support
More informationNON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) NON-ALCOHOLIC STEATOHEPATITIS (NASH) ADDRESSING A GROWING SILENT EPIDEMIC
NON-ALCOHOLIC FATTY LIVER DISEASE () & NON-ALCOHOLIC STEATOHEPATITIS () ADDRESSING A GROWING SILENT EPIDEMIC PREVALENCE OF / USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology
More informationEvaluating HIV Patient for Liver Transplantation. Marion G. Peters, MD Professor of Medicine University of California San Francisco USA
Evaluating HIV Patient for Liver Transplantation Marion G. Peters, MD Professor of Medicine University of California San Francisco USA Slide 2 ESLD and HIV Liver disease has become a major cause of death
More informationVIRAL HEPATITIS. Definitions. Acute Liver Disease (Hepatitis A &E, Alcoholic hepatitis, DILI and ALF) Acute Viral Hepatitis Symptoms
Acute Liver Disease (Hepatitis A &E, Alcoholic hepatitis, DILI and ALF) Definitions AST and ALT Markers of hepatocellular injury Ryan M. Ford, MD Assistant Professor of Medicine Director of Viral Hepatitis
More informationThe place of bariatric surgery in NASH: can we extend the indications? - No
The place of bariatric surgery in NASH: can we extend the indications? - No Nicolas Goossens Service de Gastroentérologie & Hépatologie Hôpitaux Universitaires de Genève Genève, Suisse How to extend the
More informationLiver Transplantation: The End of the Road in Chronic Hepatitis C Infection
University of Massachusetts Medical School escholarship@umms UMass Center for Clinical and Translational Science Research Retreat 2012 UMass Center for Clinical and Translational Science Research Retreat
More informationNON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) NON-ALCOHOLIC STEATOHEPATITIS (NASH) ADDRESSING A GROWING SILENT EPIDEMIC
NON-ALCOHOLIC FATTY LIVER DISEASE () & NON-ALCOHOLIC STEATOHEPATITIS () ADDRESSING A GROWING SILENT EPIDEMIC PREVALENCE OF / USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology
More informationPREVALENCE OF NAFLD & NASH
- - PREVALENCE OF & USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology 2011; 140:124-31) Dallas Heart Study Prevalence Numbers (Browning et al., Hepatology 2004;40:1387-95)
More informationAn Internist s Guide to Unhealthy Alcohol Use. Ryan Graddy, MD JHU SOM
An Internist s Guide to Unhealthy Alcohol Use Ryan Graddy, MD JHU SOM Disclosures None Learning Objectives Understand the terminology used to describe unhealthy alcohol use Identify means of screening
More informationUNIVERSITY OF CALGARY. Jack X.Q. Pang A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
UNIVERSITY OF CALGARY Epidemiology and Outcomes of Alcoholic Hepatitis in Calgary: A Population-based Study by Jack X.Q. Pang A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT
More informationManagement of autoimmune hepatitis. Pierre-Emmanuel RAUTOU Inserm U970, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France
Management of autoimmune hepatitis Pierre-Emmanuel RAUTOU Inserm U970, PARCC@HEGP, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France 41 year-old woman, coming to emergency department for fatigue
More informationRisk Factors, Scoring Systems, and Interventions for Alcohol Relapse After Liver Transplantation for Alcoholic Liver Disease
REVIEW Risk Factors, Scoring Systems, and Interventions for Alcohol Relapse After Liver Transplantation for Alcoholic Liver Disease Jane Lim, M.D.,* and Vinay Sundaram, M.D., M.Sc. Alcoholic liver disease
More informationPrognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014
Prognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014 Vlad Ratziu, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France NASH : a severe hepatic
More informationIntron A Hepatitis C. Intron A (interferon alfa-2b) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.05 Subject: Intron A Hepatitis C Page: 1 of 5 Last Review Date: November 30, 2018 Intron A Hepatitis
More informationEnterprise Interest Nothing to declare
Enterprise Interest Nothing to declare 29 th European Congress of Pathology, Amsterdam, Sept 2 nd -6 th, 2017 What s new in alcohol-mediated liver injury? Carolin Lackner Institute of Pathology Medical
More informationFATTY LIVER DISEASE (NAFLD) (NASH) A GROWING
NON ALCOHOLIC FATTY LIVER DISEASE () & NON ALCOHOLIC S T E ATO H E PAT I T I S () ADDRESSING A GROWING SILENT EPIDEMIC Prevalence of & USA Prevalence in Middle Age Patients San Antonio, Texas (Williams
More informationALCOHOLIC LIVER DISEASE (ALD) Nayan Patel, DO Transplant Hepatology/GI Banner Advanced Liver Disease and Transplant Center
ALCOHOLIC LIVER DISEASE (ALD) Nayan Patel, DO Transplant Hepatology/GI Banner Advanced Liver Disease and Transplant Center Objectives Spectrum of alcoholic liver disease Focus on Alcoholic Hepatitis (AH)
More informationHealthy Liver Cirrhosis
Gioacchino Angarano Clinica delle Malattie Infettive Università degli Studi di Foggia Healthy Liver Cirrhosis Storia naturale dell epatite HCVcorrelata in assenza di terapia Paestum 13-15 Maggio 24 The
More informationCIRROSI E IPERTENSIONE PORTALE NELLA DONNA
Cagliari, 16 settembre 2017 CIRROSI E IPERTENSIONE PORTALE NELLA DONNA Vincenza Calvaruso, MD, PhD Ricercatore di Gastroenterologia Gastroenterologia & Epatologia, Di.Bi.M.I.S. Università degli Studi di
More informationLIVER DISORDERS (PRACTICAL MANAGEMENT) Dr Pok Kern (PK) TAN Gastroenterologist Calvary hospital, ACT 1 st April 2017
LIVER DISORDERS (PRACTICAL MANAGEMENT) Dr Pok Kern (PK) TAN Gastroenterologist Calvary hospital, ACT 1 st April 2017 TOPICS TO COVER Acute liver failure Chronic liver failure Portal hypertension : Ascites
More informationLiver Transplantation Evaluation: Objectives
Liver Transplantation Evaluation: Essential Work-Up Curtis K. Argo, MD, MS VGS/ACG Regional Postgraduate Course Williamsburg, VA September 13, 2015 Objectives Discuss determining readiness for transplantation
More informationNCEPOD - Measuring the Units; A review of patients who died with alcohol-related liver disease
NCEPOD - Measuring the Units; A review of patients who died with alcohol-related liver disease Hospital Number Admission to hospital 5. Trusts should ensure that medical patients are reviewed by a consultant
More informationPhysical Aspects of Substance Misuse in Older People. Jane Collier Consultant Hepatology John Radcliffe Hospital Oxford
Physical Aspects of Substance Misuse in Older People Jane Collier Consultant Hepatology John Radcliffe Hospital Oxford Areas to cover Hepatitis C Curable disease New drugs (goodbye interferon) Drug Interactions
More information4/26/2017. Liver Transplant and Palliative Care: Teaming up to improve care
Liver Transplant and Palliative Care: Teaming up to improve care Jody C. Olson, M.D., FACP Assistant Professor of Medicine and Surgery Hepatology and Critical Care Medicine All patients with end-stage
More informationKey Aspects of Diagnosing Alcoholic Hepatitis. Mark Sonderup University of Cape Town & Groote Schuur Hospital
Key Aspects of Diagnosing Alcoholic Hepatitis Mark Sonderup University of Cape Town & Groote Schuur Hospital 42 year old woman, married with 3 children No significant co-morbidities or illnesses Habits
More informationInitial Evaluation for HCV Therapy. Hope McGratty PA-C, MPH
Initial Evaluation for HCV Therapy Hope McGratty PA-C, MPH Conflict of Interest Disclosure Statement None Who are we talking about today? Treatment naïve Chronic infection This patient seems complicated
More informationDISCLOSURES. This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea
DISCLOSURES This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea Cardea Services is approved as a provider of continuing nursing education by Montana Nurses Association,
More informationManagement of Alcoholic Hepatitis
Management of Alcoholic Hepatitis Richard K. Sterling, MD, MSc, FACP, FACG, FAASLD, AGAF VCU Hepatology Professor of Medicine Chief, Section of Hepatology Program Director, Transplant Hepatology Virginia
More informationPegylated Interferons and Ribavirins
Pegylated Interferons and Ribavirins Goal(s): Cover drugs only for those clients where there is evidence of effectiveness and safety Length of Authorization: 16 weeks plus 12-36 additional weeks or 12
More informationGEOEPIDEMIOLOGY OF PRIMARY BILIARY CIRRHOSIS IN CENTRAL GREECE
GEOEPIDEMIOLOGY OF PRIMARY BILIARY CIRRHOSIS IN CENTRAL GREECE Kalliopi Azariadis 1, Nikolaos K. Gatselis 1, Kalliopi Zachou 1, Vasiliki Lygoura 1, Pinelopi Arvaniti 1, Eirini I. Rigopoulou 1, Georgia
More informationDrug Misuse and Dependence Guidelines on Clinical Management
Department of Health Scottish Office Department of Health Welsh Office Department of Health and Social Services, Northern Ireland Drug Misuse and Dependence Guidelines on Clinical Management An Executive
More informationIssues and controversies in Liver Transplantation: The Medical Side
November 11, 2009 Issues and controversies in Liver Transplantation: The Medical Side Nizar N. Zein, M.D. Mikati Foundation Endowed Chair in Liver Diseases Medical Director, Liver Transplantation; Chief
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant. Susan Kang, RN, MSN, ANP-BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP-BC Introduction (https://www.srtr.org) What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC Introduction (https://www.srtr.org) 1 What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationBariatric Surgery For Patients With End-Organ Failure
Bariatric Surgery For Patients With End-Organ Failure Arnold D. Salzberg, M.D. Andrew M. Posselt, M.D., PhD Divisions of Transplant and Minimally Invasive Surgery University of California, San Francisco
More informationDr. John C Rwegasha.FRCP(Lond),MSc, Muhimbili National Hospital Dar es Salaam Tanzania 15/09/2018 1
Dr. John C Rwegasha.FRCP(Lond),MSc, Muhimbili National Hospital Dar es Salaam Tanzania 15/09/2018 1 No disclosures. 15/09/2018 2 Sub-Saharan Africa (SSA) has a high burden of morbidity and mortality resulting
More informationIntron A (interferon alfa-2b) with ribavirin, (Moderiba, Rebetol, Ribasphere, RibaTab, ribavirin tablets/capsules - all strengths)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.06 Subject: Intron A Ribavirin Page: 1 of 6 Last Review Date: March 18, 2016 Intron A Ribavirin Description
More information4/3/2014. Elizabeth Thompson, PharmD April Understand the importance of the liver and basic physiology.
Liver Disease Elizabeth Thompson, PharmD thompse@sarmc.org April 2014 Objectives Understand the importance of the liver and basic physiology. Review hepatic disorders Recognize liver function scoring systems
More informationOverall Goals and Objectives for Transplant Hepatology EPAs:
Overall Goals and Objectives for Transplant Hepatology EPAs: 1. DIAGNOSTIC LIST During the one-year Advanced Pediatric Transplant Hepatology Program, fellows are expected to develop comprehensive skills
More informationHepatocytes produce. Proteins Clotting factors Hormones. Bile Flow
R.J.Bailey MD Hepatocytes produce Proteins Clotting factors Hormones Bile Flow Trouble.. for the liver! Trouble for the Liver Liver Gall Bladder Common Alcohol Hep C Fatty Liver Cancer Drugs Viruses Uncommon
More informationModule 1 Introduction of hepatitis
Module 1 Introduction of hepatitis 1 Training Objectives At the end of the module, trainees will be able to ; Demonstrate improved knowledge of the global epidemiology of the viral hepatitis Understand
More informationSteps in Assessing Fibrosis 4/30/2015. Overview of Liver Disease Associated With HCV
Overview of Liver Disease Associated With HCV Marion G. Peters, MD John V. Carbone, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco San Francisco,
More informationNon-Alcoholic Fatty Liver Disease
Non-Alcoholic Fatty Liver Disease None Disclosures Arslan Kahloon M.D Chief, Division of Gastroenterology and Hepatology University of Tennessee College of Medicine Chattanooga Objectives Understand the
More informationFaculty Disclosure. Objectives. Cirrhosis Management for the Family Physician 18/11/2014
Cirrhosis Management for the Family Physician Mang Ma, MD, FRCP Professor University of Alberta Faculty: Mang Ma Faculty Disclosure Relationships with commercial interests: Advisory Board: Merck, Gilead
More informationCases: Treatment of Hepatitis C in Patients with Cirrhosis and Advanced Liver Disease
Slide 1 of 20 Cases: Treatment of Hepatitis C in Patients with Cirrhosis and Advanced Liver Disease Kenneth E. Sherman, MD, PhD Gould Professor of Medicine Director, Division of Digestive Diseases University
More informationPretreatment Evaluation
Pretreatment Evaluation Disclosures Research supported by Gilead Sciences Inc.: Site investigator for HIV/HCV SWITCH Registry Study Key personnel for FOCUS HCV Screening Program through Vanderbilt University
More informationIntron A (interferon alfa-2b) with ribavirin, (Copegus, Moderiba, Rebetol, Ribapak, Ribasphere, RibaTab, ribavirin tablets/capsules - all strengths)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Intron A Ribavirin Page: 1 of 5 Last Review Date: November 30, 2018 Intron A Ribavirin Description
More informationAlcoholic Liver Disease
14 ACG PRACTICE GUIDELINES nature publishing group CME Alcoholic Liver Disease Robert S. O Shea, MD, MSCE 1, Srinivasan Dasarathy, MD 1 and Arthur J. McCullough, MD 1 These recommendations provide a data-supported
More informationEVALUATION OF ABNORMAL LIVER TESTS
EVALUATION OF ABNORMAL LIVER TESTS MIA MANABAT DO PGY6 MOA 119 TH ANNUAL SPRING SCIENTIFIC CONVENTION MAY 19, 2018 EVALUATION OF ABNORMAL LIVER TESTS Review of liver enzymes vs liver function tests Clinical
More informationLiver Transplantation for Alcoholic Liver Disease: A Survey of Transplantation Programs in the United States
Liver Transplantation for Alcoholic Liver Disease: A Survey of Transplantation Programs in the United States James E. Everhart* and Thomas P. Beresford A lcoholic liver disease (ALD) is one of the most
More informationWHEN HCV TREATMENT IS DEFERRED WV HEPC ECHO PROJECT
WHEN HCV TREATMENT IS DEFERRED WV HEPC ECHO PROJECT October 13, 2016 Reminder - treatment is recommended for all patients with chronic HCV infection Except short life expectancies that cannot be remediated
More informationManagement of Chronic HCV. Lauren Beste, MD MSc Hepatitis C Lead Clinician, VA Puget Sound July 23, 2013
Management of Chronic HCV Lauren Beste, MD MSc Hepatitis C Lead Clinician, VA Puget Sound July 23, 2013 Pop Quiz What percent of the US population is infected with HCV? A) 0.1% B) 1.5% C) 5% D) 7% Answer
More informationHepatitis C Update on New Treatments
Hepatitis C Update on New Treatments Kevork M. Peltekian, MD, FRCPC 44th Annual Dalhousie Spring Refresher Course - Therapeutics April 5 - April 7, 2018 Halifax Convention Centre Disclosures Conflicts
More informationHepatitis Alert: Management of Patients With HCV Who Have Achieved SVR
Hepatitis Alert: Management of Patients With HCV Who Have Achieved SVR This program is supported by educational grants from AbbVie, Gilead Sciences, and Merck About These Slides Please feel free to use,
More informationWhat happens if i drink on naltrexone
+18 Seks Video XXX Sikiş Porno izle Search... Search Sort: Date View: Sort Ascending What happens if i drink on naltrexone saw & tig. For Alcohol Dependence: "I am using naltrexone per The Sinclair Method
More informationPrognosis of untreated Primary Sclerosing Cholangitis (PSC) Erik Christensen Copenhagen, Denmark
Prognosis of untreated Primary Sclerosing Cholangitis (PSC) Erik Christensen Copenhagen, Denmark Study of Prognosis of PSC Difficulties: Disease is rare The duration of the course of disease may be very
More informationHCV TREATMENT PRE- AND POST TRANSPLANTATION
HCV TREATMENT PRE- AND POST TRANSPLANTATION Mitchell L. Shiffman, MD, FACG Medical Director Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, VA, USA IVer Liver Institute
More informationSelf Provision of Alcohol and Drugs Ottawa s Managed Alcohol Program: A Fundamental Component of an Overarching Strategy for the Care of the Homeless
Self Provision of Alcohol and Drugs Ottawa s Managed Alcohol Program: A Fundamental Component of an Overarching Strategy for the Care of the Homeless April 24, 2013 Dr. Jeffrey Turnbull Founder & Medical
More informationAre we adequately screening at-risk patients for hepatocellular carcinoma in the outpatient setting?
Rajani Sharma, PGY1 Geriatrics CRC Project, 12/19/13 Are we adequately screening at-risk patients for hepatocellular carcinoma in the outpatient setting? A. Study Purpose and Rationale Hepatocellular carcinoma
More informationKing s College Hospital NHS Foundation Trust. Acute on Chronic Liver Failure: Practical management outside the tertiary centre.
King s College Hospital NHS Foundation Trust NHS Acute on Chronic Liver Failure: Practical management outside the tertiary centre. William Bernal Professor of Liver Critical Care Liver Intensive Therapy
More informationATTENDING PHYSICIAN'S STATEMENT END STAGE LIVER FAILURE / LIVER SURGERY / LIVER CIRRHOSIS
ATTENDING PHYSICIAN'S STATEMENT END STAGE LIVER FAILURE / LIVER SURGERY / LIVER CIRRHOSIS A) Patient s Particulars Name of Patient Gender NRIC/FIN or Passport No. Date of Birth (ddmmyyyy) B) Patient s
More information2. Chapter 2: Eligibility
2.1 Overview of Approach and Goals 2. Chapter 2: Eligibility The goal is to randomize 1375 participants over 18 years of age who meet DSM-IV criteria for alcohol dependence and are abstinent for a minimum
More informationDavid Bienenfeld, M.D. Wright State University Department of Psychiatry
David Bienenfeld, M.D. Wright State University Department of Psychiatry 1 Describe the epidemiologic patterns of substance abuse over age and time List the metabolic changes that influence the effect of
More informationProtocol for daclatasvir (Daklinza ) Approved October 2015 (updated February 2018)
PREFERRED AGENTS: (See drug specific NOTES for exceptions.) Protocol for daclatasvir (Daklinza ) Approved October 2015 (updated February 2018) https://providers.amerigroup.com For genotype 1, Mavyret and
More informationCirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association
CIRRHOSIS AND PORTAL HYPERTENSION Cirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association WHAT IS CIRRHOSIS? What is Cirrhosis? DEFINITION OF CIRRHOSIS
More informationNatural history of α-1-atd in children
Natural history of α-1-atd in children Agnieszka Bakuła Dpt of Gastroenterology, Hepatology, Nutrition Disorders and Paediatrics The Children s Memorial Health Institute Warsaw, Poland Topics to be discussed
More informationPretreatment Evaluation
Pretreatment Evaluation Disclosures Research supported by Gilead Sciences Inc.: Site investigator for HIV/HCV SWITCH Registry Study Key personnel for FOCUS HCV Screening Program through Vanderbilt University
More informationHepatocellular Carcinoma (HCC)
Title Slide Hepatocellular Carcinoma (HCC) Professor Muhammad Umar MBBS, MCPS, FCPS (PAK), FACG (USA), FRCP (L), FRCP (G), ASGE-M(USA), AGAF (USA) Chair & Professor of Medicine Rawalpindi Medical College
More informationNational Hepatitis plan. Dr JP Mulkay Clinic of Hepatology Department of Hepato Gastro entrology
National Hepatitis plan Dr JP Mulkay Clinic of Hepatology Department of Hepato Gastro entrology National hepatitis Plan Hepatitis B: plan non existent. People s migration from endemic countries. Reimbursement
More informationLearning Objectives. After attending this presentation, participants will be able to:
Learning Objectives After attending this presentation, participants will be able to: Describe HCV in 2015 Describe how to diagnose advanced liver disease and cirrhosis Identify the clinical presentation
More informationSeverity and Mortality Prediction in Chronic Liver Disease using Child PUGH and MELD scales
International Journal of Advanced Biotechnology and Research (IJABR) ISSN 0976-2612, Online ISSN 2278 599X, Vol-10, Issue-1, 2019, pp519-524 http://www.bipublication.com Research Article Severity and Mortality
More informationManagement of alcoholic hepatitis: Implications for options beyond the STOPAH study
Management of alcoholic hepatitis: Implications for options beyond the STOPAH study Gyongyi Szabo, MD, PhD Professor University of Massachusetts Medical School Worcester, MA Cape Town, South Africa 2015
More informationHealth Systems and Addiction: Provider Issues
Health Systems and Addiction: Provider Issues The Emerging Roles of Primary Care Patrick G. O Connor MD, MPH Dan and Amanda Adams Professor of General Medicine Chief, General Internal Medicine Yale University
More informationManagement of Ascites and Hepatorenal Syndrome. Florence Wong University of Toronto. June 4, /16/ Gore & Associates: Consultancy
Management of Ascites and Hepatorenal Syndrome Florence Wong University of Toronto June 4, 2016 6/16/2016 1 Disclosures Gore & Associates: Consultancy Sequana Medical: Research Funding Mallinckrodt Pharmaceutical:
More informationStudy Design to Validate Biomarkers of Therapeutic Response in Pre-cirrhotic NASH
Study Design to Validate Biomarkers of Therapeutic Response in Pre-cirrhotic NASH Brent A. Neuschwander-Tetri, MD, FAASLD Professor of Internal Medicine Director, Division of Gastroenterology and Hepatology
More informationAlberta Alcohol and Drug Abuse Commission. POSITION ON ADDICTION AND MENTAL HEALTH February 2007
Alberta Alcohol and Drug Abuse Commission POSITION ON ADDICTION AND MENTAL HEALTH POSITION The Alberta Alcohol and Drug Abuse Commission (AADAC) recognizes that among clients with addiction problems, there
More informationYour Health Matters. What You Need to Know about Adult Liver Transplantation. Access our patient education library online at
Access our patient education library online at www.ucsfhealth.org Your Health Matters What You Need to Know about Adult Liver Transplantation Table of Contents 1. Introduction 2. The Preliminary Process
More informationPresentation. SG is a 57 yo white man diagnosed with HCV 10 years ago now contemplating retreatment PMHx:
A HCV Dilemma Presentation SG is a 57 yo white man diagnosed with HCV 10 years ago now contemplating retreatment PMHx: Psoriasis Mild depression 5 years prior treated with PEG/RBV for 12 months HCV PCR
More information